1. Betty Albano, RN, EMT-P EMS/Injury Prevention Coordinator 2009
Elder Abuse
Betty Albano, RN, EMT-P
EMS/Injury Prevention Coordinator
2009
Starting questions:
How many of you have gone to court over an elder abuse case?
How many of you have ran a call where somebody has been turned in for elder abuse?
How many of you have reported suspected elder abuse?
How many of you have suspected elder abuse and did nothing about it because you were afraid of being wrong?

2. What is Elder Abuse
Abuse of the elderly by a caretaker, either a relative, friend, or individual upon whom the elderly person is dependent.
It is estimated that for every 1 that is reported 5 go unreported.

3. Objectives 1. Recognize possible elder abuse 2. List types of abuse
3. How to report suspected abuse

4. Who is considered elderly?
Any adult over 65 years of age.
This could include somebody that may not be as old as 65 that is medically or physically unable to care for themselves.

5. How Serious is the Problem
The U.S. has 44 million > 59 & 36 million disabled
“Reporting” up 19% since 2000
62% involve mistreatment by others – 38% involve self neglect
90% of abusers – family members
All 50 states have some type of elder abuse prevention laws.
Substantiated reports up 16% - 20 of the states more than 2 in 5 (43%) were 80+
In Ohio – 2004 APS received 12,829 reports, self neglect most common report (6,656) followed by neglect and exploitation
Types of abuse don’t change from home to institution its just the reporting that may be different.

7. True or False?
Most Elder Abuse Takes Place in Nursing Homes and Foster Care Facilities.
False: The majority of cases of Elder Abuse take place in the home setting.
Signs and symptoms will be the same regardless of where they are abused.

8. False
Most cases of Elder abuse takes place in the home setting.

9. Types of Abuse
Physical
Emotional
Sexual
Neglect
Abandonment
Financial

12. Physical Abuse
Defined As the Use of Physical Force That May Result in Bodily Injury, Physical Pain, or Impairment.

13. Physical Abuse Many different types of physical abuse.
Physical pain or injury.
Over/under medicating.
Withholding food.
Exposure to weather.
Force feeding.

14. Physical Abuse Cont. Signs and Symptoms.
Bruises, black eyes, welts, lacerations, rope marks, fractures.
Open wounds, untreated injures in different stages of healing.
Elder reporting they have been abused.
To also include sprains dislocations, internal injuries, bleeding, broken eye glasses/frames. Physical signs of being subjected to punishment and signs of being restrained. Lab findings of medication overdose or under dose. An elders report of being hit, slapped, kicked or mistreated. An elders sudden change in behavior and the caregivers refusal to allow visitors to see an elder alone.

15. Emotional Abuse
Infliction of Anguish, Pain or Distress Through Verbal or Nonverbal Acts.

16. Emotional Abuse Includes Signs and Symptoms. Verbal assaults Insults
Threats
Intimidation
Humiliation
Harassment
Signs and Symptoms.
Being emotionally upset or agitated.
Withdrawn, non-communicative.
Unusual behavior.
Elders report of being verbally or emotionally mistreated.

17. Sexual Abuse
Defined As Non Consensual Sexual Contact of Any Kind With an Elderly Person, Including Contact With Persons Incapable to Give Consent.
Considered part of physical abuse
Bruises around the breasts or genital area.
unexplained venereal disease, or infections.
Unexplained vaginal or anal bleeding.
Torn, stained, or bloody underclothing.
An elders report of being sexually assaulted or raped.

18. Neglect
Defined As the Refusal or Failure to Fulfill Any Part of a Person’s Obligations or Duties to an Elder.
Neglect by others.
Caregiver fails to provide care, food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed upon responsibility to an elder.
Self Neglect.
Person does not take care of themselves.

19. Signs and symptoms.
Dehydration, malnutrition, untreated bed sores, and poor personal hygiene.
Hazardous or unsafe living condition/arrangements.
Unsanitary and unclean living conditions.
And elders report of being mistreated.

20. Self Neglect
Behavior Of An Elderly Person That Threatens His/Her Own Health Or Safety to include a person who understands the consequences of their decisions.
Same signs and symptoms of neglect
Grossly inadequate housing.
Homelessness.
Patient if competent can neglect themselves all they want.
This is where we try and get others involved!
In self neglect you may see not only the person who is ill, “failure to thrive type of situation but houses may be filthy…..etc….

21. Abandonment
Defined As the Desertion of an Elderly Person by an Individual Who Has Assumed Responsibility for Providing Care or Has Physical Custody of an Elder.
Signs and symptoms.
The desertion of an elder at a hospital, a nursing facility, or other similar institution.
The desertion of an elder at a shopping center or public location.
An elders own report of being abandoned.

22. Financial Abuse
Defined As the Illegal or Improper Use of an Elder’s Funds, Property or Assets.

23. Financial Many other forms. Signs and symptoms.
Sudden changes in bank account.
Inclusion of additional names on bank account.
Unauthorized withdrawals.
Abrupt changes in will.
Provision of services that are not necessary.
An elders report of financial abuse.
Many other forms.

24. Why does elder abuse happen?
Caregiver Stress.
Impairment of Dependent Elder.
Cycle of Violence.
Personal problems of Abuser.
Older people live longer.
Cultural Changes in society.
Staff of facility’s overworked, under qualified and under paid.
Ask how many people have taken care of an elderly person for any length of time.
Taking care of an older person is very stressful leading to frustration and often times in these situations anger.
Impairment: poor health elders more likely to be abused than good health. Good easier to take care of.
Cycle of Violence: goes on for generations.
Personal problems of abusers: Often times are mentally ill, have drug addition and financial difficulty.
Cultural changes: People now days do not have the respect for elderly or older people that they did years ago. Our generation isn’t home for our kids what is going to happen to us. Me sense of obligation to parent. They took care of me now It’s my turn to take care of them..
Staff: frustration of elder who does not comprehend or unable to do what is asked.

25. Caregiver Symptoms Anger and hostility Over control Suspicious
Lack of empathy for the abused elder
Complaining about the burden of care taking
Anger and hostility
Over control
Overt suspicion towards the health care provider
Lack of empathy for the abused elder
Complaining about the burden of care taking

26. What Is Our Role?
Recognition
Treatment
Reporting

27. Recognition of Abuse Conflicting histories History inappropriate
Denial
Bizarre explanation.
Long delay in treatment
“Accident prone”
Conflicting histories from patient and caregiver.
History inappropriate to the type or degree of injury.
Denial in view of obvious injury.
Bizarre explanation.
Long delay in treatment from time of injury.
History of being accident prone.

28. Recognition - Patterns of abuse
Bruises in different stages of healing.
Strange looking bruises or injuries.
Bruising at the neck.
Circumferential bruising.
Injuries on the torso only.
Injuries that take the shape of an object.
Marks from electrical cord
Hand Print

29. Recognition - Cultural Differences
Lack of respect
Home
Language barriers.
Ethnic beliefs.
Religion.
Society has developed a lack of respect for the elderly.
Older people believe what goes on in the house is their business.
Language barriers.
Ethnic beliefs.
Religion.
Is it abuse or is it just a part of the patients culture. Asian people with herbal remedies. Religion Christian Scientists no medical treatment at all..??

30. Questions To Ask When Elder Abuse Is Suspected
Has anyone ever hurt you?
Has anyone touched you without your consent?
Has anyone made you do things you didn’t want to do?
Has anyone ever scolded or threatened you?

31. Questions To Ask When Elder Abuse Is Suspected
Are you afraid of anyone at home/where you live?
Do you like where you live?
Are you alone a lot?
Do you get the help you need?
Special Considerations
Elder may be afraid to admit they are being abused.
Fear of possible retaliation of caregiver.
Fear of loosing Home.
Fear of being institutionalized.
Fear of autonomy.

32. Treatment Physical Emotional
Take care of the physical..
Any significant injuries may warrant a Trauma Center
Treat the Emotional.
Treat with respect and care.
Follow local protocol call for all injuries and medical problems.

33. Reporting Who is required to report? Who do we report to?
Doctor
Police
Adult Protective Services.
See local protocols

34. Documentation Comprehensive Exact Excitable utterances documented.
Use victims own words
Record of injuries
Should be comprehensive and exact.
History obtained from victim, alleged abuser and witnesses should be recorded.
Excitable utterances documented.
Use victims own words as much as possible.
Precise recording of injuries should be made including:
Type, number, size, location of injures and explanations given a reported mechanism.
Body diagrams (on extra IR sheet).
Documentation of the behavior of the victim’s alleged abuser (in IR).
Note names of officers also.
Excitable utterances are things people say in the heat of battle (ie: oh my god I can’t believe that he did that to her”. They can be used in a court of law in most states.

35. STOP HARM Screen for abuse in all elderly patients
Think about risk factors
Ominous danger signs present?
Physical findings
History
Address of elder mistreatment
Report to Adult Protection Services
Manage with prevention and risk factor modification

36. THE BEST TIME TO LEARN HOW TO GROW OLD WITH GRACE AND DIGNITY IS DURING OUR YOUNGER YEARS AND THE BEST PLACE IS OUR EVERYDAY LIFE

37. Thank You! In advance – for taking care of me!!!
For more information go to NCEA.AOA.gov